Throughout human history, contracting consumption, the dreaded and highly contagious disease of tuberculosis, meant being ostracized from society, inexorable physical deterioration and untimely death. While there have been myriad medical advances in the past century, tuberculosis, which is spread from person to person via cough, has yet to be eradicated.
Every year nearly 9 million new tuberculosis cases and over 1.5 million deaths are attributed to tuberculosis worldwide. A vast number of these cases and deaths plague children and young adults, inflicting a painful human and significant socioeconomic toll on developing countries. Dallas County this month reported two confirmed cases of tuberculosis at W.T. White High School.
In most developed countries like the United States, few outside the medical community are aware that tuberculosis exists. How did we arrive at a point where such a vexing disease has become invisible to the general population? How did we manage to become so distantly removed from the "tuberculosis windows" mandated to be built within the overcrowded apartments of New York City tenements to prevent tuberculosis transmission by improving ventilation? How have we collectively forgotten the numerous tuberculosis sanatoriums built across the country in the last century that are now shuttered?
There is one answer: resources.
To nearly eliminate the threat of tuberculosis within their borders, wealthy, developed countries dedicated significant resources toward public health, sanitation, basic research and drug development. Generous resource allocation allowed public health officials to isolate infected, highly contagious individuals to undergo therapy while simultaneously tracking down their contacts for further testing, isolation and treatment. Improving the cramped living conditions of people living in poverty also significantly reduced the likelihood of disease acquisition. These efforts halted the spread of disease, while basic and applied research resulted in the ultimate development of multiple antibiotics that could finally cure tuberculosis.
As recently as the middle of the 20th century, tuberculosis treatments were ineffective, limited to exposure to fresh air and sunlight, improved nutrition and occasionally major surgery. Though we now possess an effective treatment regimen, tuberculosis therapy is complex, requiring daily ingestion of many pills for a minimum of six months. In developing countries, proper antibiotics are often unavailable, unaffordable to the poor, or administered incorrectly resulting in a rising incidence of difficult-to-cure, drug-resistant forms of tuberculosis. The alarming spread of drug-resistant tuberculosis represents a major threat to global health.
Because of the continued misery attributed to tuberculosis and the concerns relating to drug resistance, the United Nations has organized, for the very first time, a high-level meeting of heads of state on Sept. 26 to discuss accelerating global efforts to prevent and cure tuberculosis with an ultimate goal of disease eradication. Just as tuberculosis has become a rare disease in most developed countries because of effective and ample resource allocation, the avenue to success in the global fight against tuberculosis must be paved with resources.
The U.S., through the National Institute of Allergy and Infectious Diseases, has invested heavily in studying tuberculosis. However, the pace of investment in infectious diseases research in general and tuberculosis research in particular has not met global demand. Major goals include development of a highly efficacious tuberculosis vaccine that can truly prevent infection, invention of new, more potent antibiotics, and creation of combination antibiotic therapies that can dramatically shorten the treatment duration from months to weeks.
These goals are attainable but only through the joint efforts of researchers, doctors, nurses and public health officials along with strong and unwavering support of world leaders and governments, including our own. If we are going to banish the silent pandemic of tuberculosis, we must raise public awareness of its pervasiveness and global toll, and rededicate ourselves to our mission. In the modern era, no individual or society should suffer from such an ancient yet curable disease.
Michael Shiloh, MD, is a physician and scientist who specializes in tuberculosis research and patient care. He wrote this column for The Dallas Morning News.
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